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Crc Risk Adjustment Coder Jobs in Missouri (NOW HIRING)

Strive Health

Nurse Practitioner

Saint Louis, MO · On-site

Accurately documents and captures diagnoses to support risk adjustment (HCC coding), identify and address care gaps related to HEDIS and preventative care. * Presents patient cases and provides ...

Strive Health

Nurse Practitioner

Kansas City, MO · On-site

Accurately documents and captures diagnoses to support risk adjustment (HCC coding), identify and address care gaps related to HEDIS and preventative care. * Presents patient cases and provides ...

Strive Health

Nurse Practitioner

Kansas City, MO · On-site

Accurately documents and captures diagnoses to support risk adjustment (HCC coding), identify and address care gaps related to HEDIS and preventative care. * Presents patient cases and provides ...

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Crc Risk Adjustment Coder information

What is the difference between Crc Risk Adjustment Coder vs Medical Coder?

AspectCrc Risk Adjustment CoderMedical Coder
CertificationsCPMA, CPC, or RHIT/RHIA often preferredCPC, CCS, or CPC-H
Work EnvironmentHealthcare facilities, insurance companies, risk adjustment teamsHospitals, clinics, physician offices
Industry UsageRisk adjustment, Medicare Advantage, health plansMedical billing, coding, documentation

The Crc Risk Adjustment Coder specializes in coding for risk adjustment programs, focusing on accurate documentation for insurance and Medicare plans. Medical Coders handle a broader range of medical records and billing tasks across various healthcare settings. While both roles require coding certifications, Crc Risk Adjustment Coders focus more on risk and reimbursement accuracy within insurance programs.

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Crc Risk Adjustment Coder jobs near you

Manager Clinical Performance & Quality Coding (Nurse Practitioner or PA)

Elevance Health

Saint Louis, MO • On-site

Other

Posted 28 days ago

Elevance Health rating

7.6

Company rating: 7.6 out of 10

Based on 353 frontline employees who took The Breakroom Quiz

215th of 315 rated insurance

Job description

Manager Clinical Performance & Quality (Nurse Practitioner/Physician Assistant)

Manager Clinical Performance & Quality Coding

LOCATION: The position requires that you be in the office 3x per week. You must be within a commutable distance of one of our eligible offices.

HOURS: General business hours, Monday through Friday (8-5 central)

Hybrid 2: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

Responsible for leading the quality documentation and value capture for all provider visit medical encounters to ensure application of accurate diagnosis codes (ICD-10 codes).

Primary duties include but not limited to:

  • Serves as the primary resource and subject matter expert on all CMS Risk Adjustment and quality documentation.
  • Develop and deliver clinical focused training on advance coding and documentation while incorporating coder feedback.
  • Liaison to the clinical leadership on alignment of goals and workflows to support value capture initiatives and high-quality clinical documentation.
  • Develop performance management plan, KPI's and clinical level tracking to meet quarterly goals for coding timeliness, accuracy, and Risk Adjustment.
  • Develop and manage clinical quality reviews to ensure peer review and clinical quality chart audit process including targeting chart reviews, auditing percentages, score guidelines feedback mechanism and ensure compliance with remediation procedures.
  • Develop operational and clinical workflows for closing HEDIS care opportunities to ensure practices and health plan success.
  • Participate in peer review of medical documentation for completed visits notes as well as patient profile information in EMR.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Required Qualifications

  • Current, active, valid, and unrestricted nurse practitioner (NP) or PA license in applicable state(s) required.
  • Requires a master's in Nursing (or PA equivalent) and at least 3 years of clinical experience in applying appropriate diagnosis in the Medicare HCC Mode; or any combination of education and experience, which would provide an equivalent background.
  • Requires experience with CMS Risk Models.

Preferred Qualifications

  • You must have previous management/supervisory experience with direct reports.
  • HEDIS experience is preferred.
  • Experience with clinical data/documentation integrity is preferred (CDEO or CDEI).
  • Prefer AAPC Certified Risk Adjustment Coder (CRC) certification.

Job Level: Manager

Workshift: 1st Shift (United States of America)

Job Family: MED > Licensed Nurse

What Elevance Health employees say

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Hours and flexibility

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About Elevance Health

Sourced by ZipRecruiter

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Indianapolis, IN, US

Year founded

2004

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